Inhaled Foreign Bodies In Pediatric Patients.pdf


Aperçu du fichier PDF inhaled-foreign-bodies-in-pediatric-patients.pdf

Page 1 2 34516




Aperçu texte


stances. Although the CDC reports candy as being
the most common cause of choking episodes, the
majority of the literature indicates nuts and seeds are
the most frequently inhaled objects.12,15,16 Overall,
organic materials may be associated with a longer
length of hospitalization.17

Magnets were reported to be the most common
cause of inorganic foreign body aspiration, as well
as small objects meant for adult use, such as screws
and pins.9,18 (See Figures 1 and 2.) Smooth and
round metallic objects, such as magnets, pose an extra challenge for removal as they are difficult to grip
with standard forceps.19 Semi-rigid, rounded organic
objects, such as peanuts, have been shown to cause
higher severity foreign body-related injuries.16,20 Balloons (including rubber glove balloons) have been
reported to cause deadly choking episodes.21 As
described in a 2013 case series, blowgun darts have
become a cause of accidental foreign body inhalation
in older children.22 While less common, pen caps
are a reported inhaled foreign body in school-aged
children.23 In addition, multiple case reports identify
headscarf pins as dangerous inhaled foreign bodies
in school-aged children of certain cultures.24

The 1994 Child Safety Protection Act was enacted in an effort to prevent foreign body aspiration.
The act instituted a ban on any toys that could pose
choking or aspiration hazards for children aged
< 3 years. Any toy with small parts, marbles, or balls
measuring < 4.44 cm in size must carry a label that
the item contains small parts and is not recommended for young children.25

There are 3 typical stages in foreign body aspiration. The first is the impaction phase, characterized
by choking, gagging, and coughing paroxysms. This
may also be referred to as “penetration syndrome,"
characterized by a sudden onset of choking and
coughing, with or without vomiting.26 These symp-

toms subside during the second, or asymptomatic,
phase when the foreign body becomes lodged. This
second phase can last from hours to weeks. The third
phase is known as the complications phase, when
late sequelae such as erosion, infection, pneumonia,
and abscess can occur. According to a retrospective
study, the most common reason for late diagnosis
was misdiagnosis, usually as bronchitis.27 The use
of antibiotics and steroids for presumed infection or
inflammation can also mask symptoms and further
delay diagnosis.28,29

The most common anatomic location for a foreign
body to lodge is the bronchi (80%-90%), followed
by the trachea (3%-12%), and the larynx (2%-12%).5
Although some literature notes the right main stem
bronchus as the most common location for bronchial
foreign bodies (due to the close proximity to the vocal
cords and the less acute angle from the trachea),30
there are various other studies that report comparable
rates of right and left bronchial obstruction.5,11,14,31
The larynx is generally described as the least common
location for a foreign body to become lodged, except
in children aged < 1 year.

Differential Diagnosis
The main task in creating a differential diagnosis is differentiating an aspirated foreign body from an ingested
foreign body, and subsequent differentiation from
other conditions that can present similarly. While aspirated foreign bodies typically present with respiratory

Figure 2. Screw In The Left Mainstem
Bronchus

Figure 1. Airway Foreign Body With
Atelectasis Of The Left Lung

Reprinted from the Atlas of Pediatric Emergency Medicine, 2nd ed.,
Binita Shah, Michael Lucchesi, John Amodio, Mark Silverberg, eds.
Copyright 2013, with permission from McGraw-Hill Education.

October 2015 • www.ebmedicine.net

Reprinted from the Atlas of Pediatric Emergency Medicine, 2nd ed.,
Binita Shah, Michael Lucchesi, John Amodio, Mark Silverberg, eds.
Copyright 2013, with permission from McGraw-Hill Education.

3

Mobile app access: www.ebmedicine.net/app